In November 2024, Satyam, a 67-year-old gentleman, developed a fever with chills and rigors. Initially, he sought treatment from a local RMP (Rural Medical Practitioner), who prescribed antibiotics. However, his condition didn’t improve, and he was referred to an MD doctor in Penugonda. From there, he was sent to a medical college hospital in Eluru, where he was diagnosed with cellulitis.
As his condition worsened, with swelling and blisters developing, he was referred to Guntur Government General Hospital (GGH). Multiple debridements were performed there, and Satyam was eventually discharged with instructions to continue dressing his wounds at home. Despite these efforts, he ended up with extensive raw areas on his thigh, knee, leg, and foot.
When Satyam came to me for further advice, I found his wounds in a poor state. He was also anemic, despite having received four units of blood transfusions at GGH. Complicating matters further, he had a history of lymphedema in both lower limbs, which made the healing process more challenging.
After admitting him, I faced a dilemma: waiting for the wounds to improve sufficiently for skin grafting would take time, especially given the poor condition of his skin and the limited donor site availability. Both of his lower limbs had unhealthy skin with ulcerations, making it difficult to find adequate donor sites.
I decided to take a combined approach—improving the wound condition while simultaneously proceeding with skin grafting. Since I have access to a high-quality skin graft mesher, I opted to use meshed skin grafts. This technique allows for better coverage with limited donor skin.
My plan was straightforward:
- Use meshed skin grafts to cover the knee, lower leg, and foot. Graft harvested from right thigh.
- Leave the raw area on the left thigh, and prepare it with dressings for a future procedure once the wounds had improved further.
The rationale behind this approach was simple. If the grafts failed, the meshed skin would still contribute to improving the wound bed. On the other hand, if the grafts survived, they would significantly reduce the raw areas and expedite the healing process.
With careful planning, I was able to expand the donor skin using the mesher and achieve coverage for the most critical areas. The procedure went smoothly, and Satyam responded well in the immediate postoperative period.
This case underscores the importance of adaptability in managing complex wounds. By combining wound care with advanced skin grafting techniques, it is possible to address significant challenges, even in patients with multiple comorbidities like lymphedema and anemia.
Satyam’s journey is a reminder that thoughtful, patient-centered decisions and the judicious use of available resources can make a substantial difference in outcomes.
For those dealing with similar challenges or seeking guidance on complex wound management, feel free to reach out. Every patient’s journey is unique, and I’m here to provide personalized care tailored to their needs.
